Where doctors are needed

August 21, 2000 12:00 am

The average physician leaves medical school $91,000 in debt from medical-school bills; a new dentist owes $83,000; and a medical psychologist, $49,000. Because these professionals are so valued and, in many rural areas, so rare, the federal government offers a loan-forgiveness program to entice them to places where they are most needed. For much of its life, the program has worked well, but now, with a reauthorization deadline next month, it is out of cash and faces further underfunding.

More than half of Maine’s primary care areas – 35 of 62 – qualify for the National Loan Repayment Program. The numbers are similar for mental health and dentistry. And while these areas still need more doctors, few doubt that they would be worse off if not for the federal program and its Maine counterpart, which provides an additional $200,000 annually in state and federal dollars. But when Congress cut this year’s budget for the repayment program, the Department of Health and Human Services, which runs the program, responded by reducing the amount of money available for grants.

Worse, according to a recent report in the New York Times, the agency did not warn doctors that the cuts would affect them, even as a record number of doctors applied for the lowest amount of available money in years. The new doctors chose lower-paying jobs in under-served places only to find that while they still qualified to receive the federal money there was no money to give them. In some cases, money from the fund had to be used to pay money promised to doctors from the previous year.

In the short term, this shortfall has caused health-care facilities to look to state programs, which are unlikely to fill in the funding gap. The Maine fund used all of its funding this year for the first time in years and could have used more. Long term, the possibilities are worse. Unless doctors can afford to practice in under-served areas, the few doctors there will be overworked, more travel will be required for care, preventative medicine will become less likely and a region’s health will suffer.

The current authorization for the federal program runs out Sept. 30, but neither the Clinton administration nor the Senate budget bills have proposed returning it to adequate funding. A small gesture in the House, an additional $4 million to the current $30 million, has found support, but it is not nearly enough even to pay for the approved doctors at the qualified facilities. Adding to the size of this program’s budget is, for Congress, a relatively low-cost way to make a big impact on the shortage of health care nationwide. Ignoring the shortfall guarantees reduced health care in places that need it most and a much larger problem in the coming years.